|
QUETIAPINE 400 MG TABLET
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
NDC 60687038201
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.79 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Medicare |
$255.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: BCBS Complete |
$204.10
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: UMR Bronson Commercial |
$188.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$510.24
|
|
|
Service Code
|
NDC 60687038201
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.51 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: UMR Bronson Commercial |
$224.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3,149.74
|
|
|
Service Code
|
NDC 00310028260
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,165.40 |
| Max. Negotiated Rate |
$2,834.77 |
| Rate for Payer: Aetna American Axle |
$2,047.33
|
| Rate for Payer: Aetna Commercial |
$2,677.28
|
| Rate for Payer: Aetna Medicare |
$1,574.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.33
|
| Rate for Payer: BCBS Complete |
$1,259.90
|
| Rate for Payer: Cash Price |
$2,519.79
|
| Rate for Payer: Cofinity Commercial |
$2,204.82
|
| Rate for Payer: Cofinity Commercial |
$2,708.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,204.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,519.79
|
| Rate for Payer: Healthscope Commercial |
$2,834.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,204.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,362.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,677.28
|
| Rate for Payer: PHP Commercial |
$2,677.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,047.33
|
| Rate for Payer: Priority Health SBD |
$1,984.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,165.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,362.30
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,149.74
|
|
|
Service Code
|
NDC 00310028260
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,385.89 |
| Max. Negotiated Rate |
$2,834.77 |
| Rate for Payer: Aetna American Axle |
$2,047.33
|
| Rate for Payer: Aetna Commercial |
$2,677.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.33
|
| Rate for Payer: Cash Price |
$2,519.79
|
| Rate for Payer: Cofinity Commercial |
$2,204.82
|
| Rate for Payer: Cofinity Commercial |
$2,708.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,204.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,519.79
|
| Rate for Payer: Healthscope Commercial |
$2,834.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,204.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,362.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,677.28
|
| Rate for Payer: PHP Commercial |
$2,677.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,047.33
|
| Rate for Payer: Priority Health SBD |
$1,984.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,385.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,362.30
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$433.92
|
|
|
Service Code
|
NDC 00904680361
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.92 |
| Max. Negotiated Rate |
$390.53 |
| Rate for Payer: Aetna American Axle |
$282.05
|
| Rate for Payer: Aetna Commercial |
$368.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.05
|
| Rate for Payer: Cash Price |
$347.14
|
| Rate for Payer: Cofinity Commercial |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$373.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.14
|
| Rate for Payer: Healthscope Commercial |
$390.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.83
|
| Rate for Payer: PHP Commercial |
$368.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.05
|
| Rate for Payer: Priority Health SBD |
$273.37
|
| Rate for Payer: UMR Bronson Commercial |
$190.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.44
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$152.19
|
|
|
Service Code
|
NDC 68180061407
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$136.97 |
| Rate for Payer: Aetna American Axle |
$98.92
|
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.92
|
| Rate for Payer: Cash Price |
$121.75
|
| Rate for Payer: Cofinity Commercial |
$106.53
|
| Rate for Payer: Cofinity Commercial |
$130.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.75
|
| Rate for Payer: Healthscope Commercial |
$136.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.36
|
| Rate for Payer: PHP Commercial |
$129.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.92
|
| Rate for Payer: Priority Health SBD |
$95.88
|
| Rate for Payer: UMR Bronson Commercial |
$66.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.14
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$433.92
|
|
|
Service Code
|
NDC 00904680361
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$390.53 |
| Rate for Payer: Aetna American Axle |
$282.05
|
| Rate for Payer: Aetna Commercial |
$368.83
|
| Rate for Payer: Aetna Medicare |
$216.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.05
|
| Rate for Payer: BCBS Complete |
$173.57
|
| Rate for Payer: Cash Price |
$347.14
|
| Rate for Payer: Cofinity Commercial |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$373.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.14
|
| Rate for Payer: Healthscope Commercial |
$390.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.83
|
| Rate for Payer: PHP Commercial |
$368.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.05
|
| Rate for Payer: Priority Health SBD |
$273.37
|
| Rate for Payer: UMR Bronson Commercial |
$160.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.44
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$152.19
|
|
|
Service Code
|
NDC 68180061407
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.31 |
| Max. Negotiated Rate |
$136.97 |
| Rate for Payer: Aetna American Axle |
$98.92
|
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Aetna Medicare |
$76.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.92
|
| Rate for Payer: BCBS Complete |
$60.88
|
| Rate for Payer: Cash Price |
$121.75
|
| Rate for Payer: Cofinity Commercial |
$106.53
|
| Rate for Payer: Cofinity Commercial |
$130.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.75
|
| Rate for Payer: Healthscope Commercial |
$136.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.36
|
| Rate for Payer: PHP Commercial |
$129.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.92
|
| Rate for Payer: Priority Health SBD |
$95.88
|
| Rate for Payer: UMR Bronson Commercial |
$56.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.14
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$282.72
|
|
|
Service Code
|
NDC 16729009612
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cofinity Commercial |
$197.90
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.77
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: UMR Bronson Commercial |
$124.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4,041.96
|
|
|
Service Code
|
NDC 00310028360
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,495.53 |
| Max. Negotiated Rate |
$3,637.76 |
| Rate for Payer: Aetna American Axle |
$2,627.27
|
| Rate for Payer: Aetna Commercial |
$3,435.67
|
| Rate for Payer: Aetna Medicare |
$2,020.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,627.27
|
| Rate for Payer: BCBS Complete |
$1,616.78
|
| Rate for Payer: Cash Price |
$3,233.57
|
| Rate for Payer: Cofinity Commercial |
$2,829.37
|
| Rate for Payer: Cofinity Commercial |
$3,476.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,829.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,233.57
|
| Rate for Payer: Healthscope Commercial |
$3,637.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,829.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,031.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,435.67
|
| Rate for Payer: PHP Commercial |
$3,435.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,627.27
|
| Rate for Payer: Priority Health SBD |
$2,546.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,495.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,031.47
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,041.96
|
|
|
Service Code
|
NDC 00310028360
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,778.46 |
| Max. Negotiated Rate |
$3,637.76 |
| Rate for Payer: Aetna American Axle |
$2,627.27
|
| Rate for Payer: Aetna Commercial |
$3,435.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,627.27
|
| Rate for Payer: Cash Price |
$3,233.57
|
| Rate for Payer: Cofinity Commercial |
$2,829.37
|
| Rate for Payer: Cofinity Commercial |
$3,476.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,829.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,233.57
|
| Rate for Payer: Healthscope Commercial |
$3,637.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,829.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,031.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,435.67
|
| Rate for Payer: PHP Commercial |
$3,435.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,627.27
|
| Rate for Payer: Priority Health SBD |
$2,546.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,778.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,031.47
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$282.72
|
|
|
Service Code
|
NDC 16729009612
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.61 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna Medicare |
$141.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: BCBS Complete |
$113.09
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cofinity Commercial |
$197.90
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.77
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: UMR Bronson Commercial |
$104.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$220.02
|
|
|
Service Code
|
NDC 68180061507
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.81 |
| Max. Negotiated Rate |
$198.02 |
| Rate for Payer: Aetna American Axle |
$143.01
|
| Rate for Payer: Aetna Commercial |
$187.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.01
|
| Rate for Payer: Cash Price |
$176.02
|
| Rate for Payer: Cofinity Commercial |
$154.01
|
| Rate for Payer: Cofinity Commercial |
$189.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.02
|
| Rate for Payer: Healthscope Commercial |
$198.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.02
|
| Rate for Payer: PHP Commercial |
$187.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.01
|
| Rate for Payer: Priority Health SBD |
$138.61
|
| Rate for Payer: UMR Bronson Commercial |
$96.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.01
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$220.02
|
|
|
Service Code
|
NDC 68180061507
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.41 |
| Max. Negotiated Rate |
$198.02 |
| Rate for Payer: Aetna American Axle |
$143.01
|
| Rate for Payer: Aetna Commercial |
$187.02
|
| Rate for Payer: Aetna Medicare |
$110.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.01
|
| Rate for Payer: BCBS Complete |
$88.01
|
| Rate for Payer: Cash Price |
$176.02
|
| Rate for Payer: Cofinity Commercial |
$154.01
|
| Rate for Payer: Cofinity Commercial |
$189.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.02
|
| Rate for Payer: Healthscope Commercial |
$198.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.02
|
| Rate for Payer: PHP Commercial |
$187.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.01
|
| Rate for Payer: Priority Health SBD |
$138.61
|
| Rate for Payer: UMR Bronson Commercial |
$81.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.01
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$469.44
|
|
|
Service Code
|
NDC 00904680461
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.69 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna American Axle |
$305.14
|
| Rate for Payer: Aetna Commercial |
$399.02
|
| Rate for Payer: Aetna Medicare |
$234.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.14
|
| Rate for Payer: BCBS Complete |
$187.78
|
| Rate for Payer: Cash Price |
$375.55
|
| Rate for Payer: Cofinity Commercial |
$328.61
|
| Rate for Payer: Cofinity Commercial |
$403.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.55
|
| Rate for Payer: Healthscope Commercial |
$422.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.02
|
| Rate for Payer: PHP Commercial |
$399.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.14
|
| Rate for Payer: Priority Health SBD |
$295.75
|
| Rate for Payer: UMR Bronson Commercial |
$173.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.08
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$469.44
|
|
|
Service Code
|
NDC 00904680461
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna American Axle |
$305.14
|
| Rate for Payer: Aetna Commercial |
$399.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.14
|
| Rate for Payer: Cash Price |
$375.55
|
| Rate for Payer: Cofinity Commercial |
$328.61
|
| Rate for Payer: Cofinity Commercial |
$403.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.55
|
| Rate for Payer: Healthscope Commercial |
$422.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.02
|
| Rate for Payer: PHP Commercial |
$399.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.14
|
| Rate for Payer: Priority Health SBD |
$295.75
|
| Rate for Payer: UMR Bronson Commercial |
$206.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.08
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,686.98
|
|
|
Service Code
|
NDC 00310028060
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$624.18 |
| Max. Negotiated Rate |
$1,518.28 |
| Rate for Payer: Aetna American Axle |
$1,096.54
|
| Rate for Payer: Aetna Commercial |
$1,433.93
|
| Rate for Payer: Aetna Medicare |
$843.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.54
|
| Rate for Payer: BCBS Complete |
$674.79
|
| Rate for Payer: Cash Price |
$1,349.58
|
| Rate for Payer: Cofinity Commercial |
$1,180.89
|
| Rate for Payer: Cofinity Commercial |
$1,450.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,180.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.58
|
| Rate for Payer: Healthscope Commercial |
$1,518.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,180.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,265.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.93
|
| Rate for Payer: PHP Commercial |
$1,433.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.54
|
| Rate for Payer: Priority Health SBD |
$1,062.80
|
| Rate for Payer: UMR Bronson Commercial |
$624.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,265.23
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,686.98
|
|
|
Service Code
|
NDC 00310028060
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$742.27 |
| Max. Negotiated Rate |
$1,518.28 |
| Rate for Payer: Aetna American Axle |
$1,096.54
|
| Rate for Payer: Aetna Commercial |
$1,433.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.54
|
| Rate for Payer: Cash Price |
$1,349.58
|
| Rate for Payer: Cofinity Commercial |
$1,180.89
|
| Rate for Payer: Cofinity Commercial |
$1,450.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,180.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.58
|
| Rate for Payer: Healthscope Commercial |
$1,518.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,180.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,265.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.93
|
| Rate for Payer: PHP Commercial |
$1,433.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.54
|
| Rate for Payer: Priority Health SBD |
$1,062.80
|
| Rate for Payer: UMR Bronson Commercial |
$742.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,265.23
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$301.92
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.84 |
| Max. Negotiated Rate |
$271.73 |
| Rate for Payer: Aetna American Axle |
$196.25
|
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.25
|
| Rate for Payer: Cash Price |
$241.54
|
| Rate for Payer: Cofinity Commercial |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$259.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.54
|
| Rate for Payer: Healthscope Commercial |
$271.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.63
|
| Rate for Payer: PHP Commercial |
$256.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.25
|
| Rate for Payer: Priority Health SBD |
$190.21
|
| Rate for Payer: UMR Bronson Commercial |
$132.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.44
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$301.92
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.71 |
| Max. Negotiated Rate |
$271.73 |
| Rate for Payer: Aetna American Axle |
$196.25
|
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna Medicare |
$150.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.25
|
| Rate for Payer: BCBS Complete |
$120.77
|
| Rate for Payer: Cash Price |
$241.54
|
| Rate for Payer: Cofinity Commercial |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$259.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.54
|
| Rate for Payer: Healthscope Commercial |
$271.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.63
|
| Rate for Payer: PHP Commercial |
$256.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.25
|
| Rate for Payer: Priority Health SBD |
$190.21
|
| Rate for Payer: UMR Bronson Commercial |
$111.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.44
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$143.82
|
|
|
Service Code
|
NDC 68180061207
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna American Axle |
$93.48
|
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.48
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UMR Bronson Commercial |
$63.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$143.82
|
|
|
Service Code
|
NDC 68180061207
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna American Axle |
$93.48
|
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna Medicare |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: BCBS Complete |
$57.53
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.48
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UMR Bronson Commercial |
$53.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$1,885.15
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
12197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$697.51 |
| Max. Negotiated Rate |
$1,696.63 |
| Rate for Payer: Aetna American Axle |
$1,225.35
|
| Rate for Payer: Aetna Commercial |
$1,602.38
|
| Rate for Payer: Aetna Medicare |
$942.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.35
|
| Rate for Payer: BCBS Complete |
$754.06
|
| Rate for Payer: Cash Price |
$1,508.12
|
| Rate for Payer: Cofinity Commercial |
$1,319.61
|
| Rate for Payer: Cofinity Commercial |
$1,621.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,319.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,508.12
|
| Rate for Payer: Healthscope Commercial |
$1,696.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,319.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,413.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,602.38
|
| Rate for Payer: PHP Commercial |
$1,602.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,225.35
|
| Rate for Payer: Priority Health SBD |
$1,187.64
|
| Rate for Payer: UMR Bronson Commercial |
$697.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,413.86
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$1,885.15
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
12197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$829.47 |
| Max. Negotiated Rate |
$1,696.63 |
| Rate for Payer: Aetna American Axle |
$1,225.35
|
| Rate for Payer: Aetna Commercial |
$1,602.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.35
|
| Rate for Payer: Cash Price |
$1,508.12
|
| Rate for Payer: Cofinity Commercial |
$1,319.61
|
| Rate for Payer: Cofinity Commercial |
$1,621.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,319.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,508.12
|
| Rate for Payer: Healthscope Commercial |
$1,696.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,319.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,413.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,602.38
|
| Rate for Payer: PHP Commercial |
$1,602.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,225.35
|
| Rate for Payer: Priority Health SBD |
$1,187.64
|
| Rate for Payer: UMR Bronson Commercial |
$829.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,413.86
|
|
|
QUINIDINE SULFATE 200 MG TABLET
|
Facility
|
OP
|
$1,245.98
|
|
|
Service Code
|
NDC 42806051330
|
| Hospital Charge Code |
6777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.01 |
| Max. Negotiated Rate |
$1,121.38 |
| Rate for Payer: Aetna American Axle |
$809.89
|
| Rate for Payer: Aetna Commercial |
$1,059.08
|
| Rate for Payer: Aetna Medicare |
$622.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.89
|
| Rate for Payer: BCBS Complete |
$498.39
|
| Rate for Payer: Cash Price |
$996.78
|
| Rate for Payer: Cofinity Commercial |
$1,071.54
|
| Rate for Payer: Cofinity Commercial |
$872.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$872.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$996.78
|
| Rate for Payer: Healthscope Commercial |
$1,121.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$872.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$934.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,059.08
|
| Rate for Payer: PHP Commercial |
$1,059.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.89
|
| Rate for Payer: Priority Health SBD |
$784.97
|
| Rate for Payer: UMR Bronson Commercial |
$461.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$934.49
|
|
